Queen Margaret Hospital
Renal Unit (Fife)
Clinical Standards Board for Scotland
(now part of NHS Quality Improvement Scotland)
Local Report on service provision for
Adult Renal Services
Renal failure is becoming increasingly common in Scotland. The condition and
its treatment impacts greatly on a patient's life and work. Although no cure
exists for renal failure, there is much that can be done to improve outcomes and
quality of life for patients.
The Clinical Standards Board for Scotland (CSBS) Adult Renal Services Project
Group focused on care provided in renal units for adults throughout Scotland.
It developed 14 standards relating to the main areas of care for adults with renal
failure. There was a particular focus on chronic renal failure, as this represents
the vast majority of the workload in renal units. This report presents the findings
from the CSBS peer review of performance against the standards.
This report was undertaken by CSBS in late 2002, and has been prepared and published by
NHS Quality Improvement Scotland (NHS QIS). CSBS work was incorporated into NHS QIS
on 1 January 2003.
1 Setting the Scene
2.1 How the Standards were Developed 5
2.2 How the Review Process Works 6
Summary of Findings 10
2.3 Overview of Local Service Provision 10
2.4 Summary of Findings Against the Standards 15
Detailed Findings Against the Standards 21
Appendix 1 Glossary of Abbreviations 36
Appendix 2 Review Team Members 37
Appendix 3 Adult Renal Services Project Group 38
Appendix 4 Timetable of Visits 40
Standard 6 - Clinical Management/Treatment 6: Drug Therapy
All people with chronic renal failure or on renal replacement therapy receive appropriate drug
therapy and advice on their medicines.
Queen Margaret Hospital Renal Unit, Fife
1.1: There are protocols for: Management of anaemia; Treatment of peritonitis;
Immunisation for Hepatitis B.
STATUS: Well-developed protocols are in place for the management of
Not met treatment of peritonitis. While there is no protocol for
hepatitis B, the review team noted that the unit is planning to produce a
protocol in the near future.
1.2: In addition, for transplant units there are protocols for: Immunosuppressive
regimens; Cytomegalovirus and pneumocystis infection prophylaxis; Renal vein
thrombosis prophylaxis; Management of delayed graft function.
STATUS: Although Queen Margaret Hospital is not a transplant unit, the
Not applicable noted that the renal pharmacist has copies of the required protocols
Royal Infirmary of Edinburgh Transplant Unit and demonstrated good
awareness of these protocols.
2: All patients' prescriptions are reviewed to ensure their drug therapy is appropriate for
STATUS: In-patients' prescriptions are reviewed daily during ward rounds.
Me t patients' prescriptions are reviewed by medical staff at clinics, with
being referred to the renal pharmacist. All other patients'
prescriptions are reviewed in rotation at the weekly multidisciplinary
meetings, with each patient being reviewed on a monthly basis. The
renal pharmacist attends the weekly meetings and brings patients'
prescriptions to the meetings for review. The renal pharmacist
informs patients of any changes to their prescriptions. The review
team noted that prescriptions are not reviewed if the renal pharmacist
is on annual leave or sick leave. It was reported that the unit is aware
of this and is looking at how this gap may be covered.
3: Information and advice about the use of drugs in chronic renal failure or in dialysis
patients is available to healthcare professionals and renal patients.
STATUS: The review team commended the quality of information available to
Me t about the use of drugs in chronic renal failure or dialysis patients.
provided with a detailed, individualised drug chart, which
includes a description of each drug, when they must be taken and
the purpose of each drug. An education pack containing written
information about the drugs used in chronic renal failure or dialysis
is provided to both patients and healthcare professionals. In addition
the renal pharmacist gives tutorials for small groups of staff and
patients and is also available for advice within the ward.
4: There is a designated pharmacist with a recognised postgraduate qualification and/
or renal experience.
STATUS: There is a designated renal pharmacist with a recognised
Me t qualification and renal experience.